Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG?

Abstract

ObjectiveIn this study, we investigated the role of two of the recent biomarkers of inflammation on the development of acute kidney injury in the early postoperative period of isolated coronary artery bypass grafting.MethodsThree hundred and eleven patients, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass by the same surgery team in our clinic between May 2010 and October 2014, who had a preoperative serum creatinine level lower than 1.5 mg/dl were included in the study. These patients' records were reviewed retrospectively. The diagnosis of acute kidney injury was performed according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline criteria. Patients who developed acute kidney injury in the early postoperative period were classified as Group-1 (n=62) and the patients with normal postoperative renal functions were classified as Group-2 (n=249). The demographic data, body mass index, comorbidities, hematologic/biochemical profiles, preoperative ejection fraction, blood transfusion history, and operative data of the groups were compared. Univariate analyses were performed to determine significant clinical factors, and multiple logistic regression analyses were subsequently done to determine independent predictors of acute kidney injury.ResultsSixty-two (19.9%) patients developed acute kidney injury during the first 72 hours postoperatively. Multivariate logistic regression analyses revealed preoperative increased creatinine (P=0.0001), C-reactive protein (P=0.02), neutrophil-lymphocyte ratio (P=0.04) and platelet-lymphocyte ratio (P=0.002); increased postoperative first day leukocyte count (P=0.03), C-reactive protein levels (P=0.02), neutrophil-lymphocyte ratio (P=0.002), platelet-lymphocyte ratio (P=0.01) and increased intubation time (P=0.006) as independent predictors of early postoperative acute kidney injury in patients who underwent isolated coronary artery bypass grafting.ConclusionThe preoperative and postoperative increased levels of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio which can be calculated by simple methods from routine blood analysis showed us that these parameters are independent biomarkers directly related to development of acute kidney injury in the early postoperative period.

Complete blood count in acute kidney injury prediction: a narrative review

“…In the setting of cardiac surgery, Parlar et al also demonstrated that an elevated preoperative PLR was associated with early postoperative AKI [OR 1.06 (1.01–1.10), p = 0.01] [66]. The cut-off value to predict AKI determined in this study was 136.85, which demonstrated a sensitivity of 71.0% and specificity of 70.7% [66].…”

“…In a retrospective cohort of 590 patients undergoing cardiovascular surgery, postoperative elevated NLR was significantly associated with an increased risk of postoperative AKI and mortality [65]. Parlar et al also demonstrated that an increased NLR was associated with postoperative AKI in patients undergoing cardiovascular surgery with cardiopulmonary bypass [66]. An elevated preoperative NLR was also documented as a predictor of AKI in burn surgery patients, in whom a cut-off value of 11.7 was optimal for postoperative AKI prediction (OR 1.094 (1.064–1.125), p < 0.001) [67].…”

Inflammatory Biomarkers in Cardiac Surgery and the Suggestion of an Editors’ Heart Team

“…Thus, the tendency to search for an inexpensive and easy-to-use biomarker is observed, increasing interest in "old biomarkers" such as C-reactive protein, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This trend may be noted in recent publications in the Brazilian Journal of Cardiovascular Surgery (BJCVS) [4] .…”

Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio May Contribute Little Compared to Standard Preoperative Evaluation

“…A recent paper published in Brazilian Journal of Cardiovascular Surgery (BJCVS) introduces platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) as two novel index to predict development of postoperative acute kidney injury (AKI) of isolated coronary artery bypass grafting [1] . This case-control study included a wide range of patients with AKI ( i.e .…”